Schizophrenia is a serious mental illness. An individual with this illness loses touch with reality. People with schizophrenia have disturbances in their emotions, thoughts and behaviour further leading to impairments in the overall functioning. A person with schizophrenia may experience hallucinations (hearing voices, seeing people, having bitter taste in the mouth, feeling something is crawling on them, smelling odour / bad when any of this is not present), delusions (feeling people are against them or trying to kill them, feeling they are special and have special powers to help people, feeling their spouse is cheating on them, feeling that people are talking about them), negative symptoms (where the person socially withdraws, doesn’t feeling like doing activities, personal hygiene and self-care deteriorates, blunted affected, poor motivation). In chronic schizophrenia cases, patients start to face impairments in different areas of their life. The affected areas during the course of illness are such as activities of daily living, work life, community/social interactions, deficits in learning skills, deficits in communication skills etc. In such cases, the symptoms are reduced over time but deficits in the functioning of a person lead to more dependency on the caregivers. Hence it becomes important to address them during the course of treatment.
So let’s start by understanding what rehabilitation is? Rehabilitation is a process aimed at bringing the affected person / ill person to resume his / her normal life to its optimal level of functioning. During the rehabilitation process areas such as physical, mental, emotional, social, occupational are important to consider.
In the process of rehabilitating a person with schizophrenia, a multi-disciplinary team consisting of professionals such as psychiatrist, psychologist, social worker, occupational therapist and nurses’ work together to help patients reduce their dependency on others and achieve the highest level of functioning.
The approach to the treatment is based on the biopsychosocial model. The first step towards the treatment would be managing the acute difficulties such as symptoms of the patient such as hallucinations, delusions, disorganized speech and negative symptoms. These are managed using a pharmacological treatment like antipsychotics and clinical observation in the inpatient department. Psychosocial aspects are also addressed side by side. Once the patient is managed symptomatically, psychological management therapies such as cognitive behavioural therapy, cognitive remediation therapy, and family-based interventions along with education about the signs and symptoms of illness are carried out by clinical psychologist with the patient and caregiver/family.
Along with the medicines and psychological treatment, it becomes important to address issues related to the functionality of the affected person and help him get back to doing things as before the initiation of illness. Here comes the role of social workers and occupational therapists. The social worker and occupational therapists train patients in skills required for independent functioning. It includes skills required for maintaining personal hygiene and self-care, understanding emotions, managing technology, money management, training in vocational skills, making a plan for sustainable occupational, communication skills etc. According to the interests of the patients and availability of resources, social workers and occupational therapists engage patient into meaningful occupations which keep them occupied and as well as supports them financially. The social worker also helps in providing for social entitlements such as patient disability certificates and schemes available in the state for people with disability.